Provider Demographics
NPI:1063295467
Name:MATTINGLY, COURTNEY ANALIE (RDH)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANALIE
Last Name:MATTINGLY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 KESSLER FARM DR APT 305
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-7108
Mailing Address - Country:US
Mailing Address - Phone:774-551-6012
Mailing Address - Fax:
Practice Address - Street 1:15 KESSLER FARM DR APT 305
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-7108
Practice Address - Country:US
Practice Address - Phone:774-551-6012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No174400000XOther Service ProvidersSpecialist